Performance - 360 Degree Feedback Survey Sample #5

360-Degree Assessment Survey

Dear Employee:

Thank you for participating in a 360-degree feedback assessment. In this process, you will complete a self-assessment questionnaire (below). You will also receive feedback from others including your manager, peers and direct reports. As you respond, please respond using just your experiences in the past 12 months. Rate each item using the scale shown. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the Closing Comments section. Your responses will be compiled with feedback from others and presented to you at the conclusion of this assessment to help guide your ongoing professional development.

Partially completed forms can be saved by using the Save/Still Working button at the bottom of the page. You may return at a later time to complete/edit the form. Your saved responses will be shown each time you re-visit the feedback form. When you are certain that you have completed your responses and will be not making any changes, click the Complete button.

Please ensure that your submission is made by .

Thank you for your participation in the survey.

Management Team

Performance	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You work effectively in the department.
You are effective in performing your job.
You are able to organize work.
You listen and respond to issues and problems
You effectively organize resources and plans
Developing Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You assess employees' developmental needs.
You create opportunities for professional development.
You set performance objectives for subordinates that encourages development opportunities.
You develop employees by offering and encouraging them to take on new or additional responsibilities.
You encourage employees through recognition of positive changes in behavior.
Conflict Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You clearly express expectations to others.
You try to understand others' point of view before making judgments
You identify and takes steps to prevent potential confrontations.
You deal effectively with employee grievances.
You assist team members by helping them see the other point of view.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You focus attention on treating the causes of problems rather than simply addressing the symptoms.
You look for opportunities to enhance contributions to the bottom line.
You sustain or achieves a competitive advantage for the organization by analyzing the best practices and lessons learned from other organizations.
You communicate goals and objectives to employees.
You understand your role within the organization.
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You develop budgets and plans for various programs and initiatives.
You monitor expenses and verify the need for items purchased.
You ensure others follow the correct rules and regulations on fiscal matters.
You develop of the department's annual budget.
You keep excellent records for financial transparency.
Planning	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You anticipate potential challenges, develops plan to overcome them and then carries out the plan.
You are able to look ahead (beyond the present) when addressing the work/needs of the department.
You are able to identify the needs of the department before a major change.
You anticipate obstacles and ways to overcome them.
You work in an organized manner

31. Overall, please rate the effectiveness of [Participant Name Here].
    

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
32. Strengths
    
    
    
33. Areas for Development
    
    
    
34. Please give any final comments or suggestions for [Participant Name Here]'s assessment.